ArticleEuropean journal of epidemiology2024
Bias assessment and correction for Levin's population attributable fraction in the presence of confounding.
Article in European journal of epidemiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- The frailty mortality link in people with chronic diseases pertaining to 13 body organ systems: findings from the UK Biobank study.GeroScience · 2026Article
- Estimated preventable fraction of chronic disease attributed to long-term physical activity and diet quality, independent of body weight: a prospective cohort study of three US cohorts.Lancet regional health. Americas · 2026Article
- Global disparities in realized stroke prevention attributable to antihypertensive treatment: a population-level analysis of 198 countries, 1990-2019.European journal of epidemiology · 2026Article
- Population attributable fractions of modifiable dementia risk factors in the Netherlands: a cross-sectional, time series analysis.EClinicalMedicine · 2026Article
- [Apply the Miettinen Formula to Assess the Health Benefits of the PMSichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2026Article
- Nicotine consumption and folate insufficiency in pregnancy: a population-based cross-sectional study.The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians · 2025Article
- Prioritizing interventions for echinococcosis prevention in China: a population attributable fraction analysis.The Lancet regional health. Western Pacific · 2025Article
- Dementia risk reduction in China: Country-specific estimates of modifiable risk factors and population attributable fractions (PAFs).Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Maternal Anaemia and Congenital Heart Disease in Offspring: A Case-Control Study Using Linked Electronic Health Records in the United Kingdom.BJOG : an international journal of obstetrics and gynaecology · 2025Article
- Calculating preventable risk fractions for exposure-reducing interventions.Global epidemiology · 2025Article
- Cancers attributable to diet in Italy.International journal of cancer · 2025Article
- Reevaluating the fraction of cancer attributable to excess weight: overcoming the hidden impact of prediagnostic weight loss.European journal of epidemiology · 2024Article
- Estimating and displaying population attributable fractions using the R package: graphPAF.European journal of epidemiology · 2024Article
- Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021.The Lancet. Infectious diseases · 2024Article
- Population attributable fraction of gas cooking and childhood asthma: What was missed?Global epidemiology · 2024Article
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5 authors.
Funding
Abstract
In 1953, Morton Levin introduced a simple approach to estimating population attributable fractions (PAF) depending only on risk factor prevalence and relative risk. This formula and its extensions are still in widespread use today, particularly to estimate PAF in populations where individual data is unavailable. Unfortunately, Levin's approach is known to be asymptotically biased for the PAF when the risk factor-disease relationship is confounded even if relative risks that are correctly adjusted for confounding are used in the estimator. Here we describe a simple re-expression of Miettinen's estimand that depends on the causal relative risk, the unadjusted relative risk and the population risk factor prevalence. While this re-expression is not new, it has been underappreciated in the literature, and the associated estimator may be useful in estimating PAF in populations when individual data is unavailable provided estimated adjusted and unadjusted relative risks can be transported to the population of interest. Using the re-expressed estimand, we develop novel analytic formulae for the relative and absolute asymptotic bias in Levin's formula, solidifying earlier work by Darrow and Steenland that used simulations to investigate this bias. We extend all results to settings with non-binary valued risk factors and continuous exposures and discuss the utility of these results in estimating PAF in practice.
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